Provider Demographics
NPI:1689743486
Name:KANTRO, ALAN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:KANTRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5204
Mailing Address - Country:US
Mailing Address - Phone:631-667-2542
Mailing Address - Fax:631-667-2926
Practice Address - Street 1:1729 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5204
Practice Address - Country:US
Practice Address - Phone:631-667-2542
Practice Address - Fax:631-667-2926
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0354761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice